Provider Demographics
NPI:1801822853
Name:JOHNSTON, MICHAEL JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JOSEPH
Last Name:JOHNSTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 ELTON HILLS DR NW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55901-3562
Mailing Address - Country:US
Mailing Address - Phone:507-529-6600
Mailing Address - Fax:507-529-6677
Practice Address - Street 1:102 ELTON HILLS DR NW
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55901-3562
Practice Address - Country:US
Practice Address - Phone:507-529-6616
Practice Address - Fax:507-529-6622
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2012-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01063646A2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN146470E2OtherMEDICARE ID
IN200882000Medicaid
IN200882000Medicaid